Provider Demographics
NPI:1467550087
Name:EDISTO REGIONAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:EDISTO REGIONAL HEALTH SERVICES INC
Other - Org Name:RMC SANTEE EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-395-4248
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1245
Mailing Address - Country:US
Mailing Address - Phone:803-395-4497
Mailing Address - Fax:
Practice Address - Street 1:111 JOHN LAWSON AVE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29142-8654
Practice Address - Country:US
Practice Address - Phone:803-395-2070
Practice Address - Fax:803-395-2097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE REGIONAL MEDICAL CENTER OF ORANGEBURG AND CALHOUN COUNTIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC400685Medicaid
SCGP5587Medicaid
SCGP5587Medicaid